Assemblyman McDonough Announces Agreement And Legislation That Would Rank New York Doctors

New Yorkers seeking the best health care for themselves and their families will soon have a useful tool at their disposal. As part of an agreement reached between CIGNA Healthcare and the New York State Attorney General, a model has been created that will rank New York’s doctors. The model will serve as a template for legislation to be introduced by state lawmakers, and will be the first in the nation to codify how insurers rank doctors within their provider networks.

“Access to the ranking model will allow individuals and families to select their physician based on the quality of health care they have delivered to past patients, not on the ability to save providers money,” said McDonough. “The quality of health care should never override the cost of providing health care to New Yorkers.”

The legislative agreement comes after several major health insurers agreed to adopt a ranking model created by CIGNA Healthcare. The model was created after the Attorney General’s office launched an investigation into health insurers’ doctor ranking programs and concerns that the insurance providers may be steering their members to physicians based on price rather than quality of care.

In addition to CIGNA, the other health insurance providers who have agreed to follow the model’s requirements are: Aetna Inc.; Empire Blue Cross Blue Shield; UnitedHealthcare; Oxford Health Plans; Group Health Inc. and Health Insurance Plan of Greater New York, which are subsidiaries of Emblem Health Inc.; and MVP Healthcare and its Preferred Health affiliate.

Under the terms of the legislative agreement, all health insurers operating in New York will be required to ensure that their doctor ranking programs include established national standards to measure quality in addition to cost, and to disclose to consumers and physicians how the rankings are determined. The ranking must be broken down by cost, quality and, when a combined score is given, what proportion is based on cost vs. quality. Additionally, the insurers also must submit to outside oversight by a ratings examiner.

In response to New York’s announcement, the Chicago-based American Medical Association commended New York lawmakers for seeking legislation that would codify “the safeguards necessary to ensure the integrity of physician profiling initiatives.”